Asunto(s)
Influenza Pandémica, 1918-1919 , Gripe Humana , Neumonía Viral , Humanos , Masculino , Adulto Joven , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Radiografía Torácica , Fiebre/diagnóstico , Fiebre/etiología , Tos/diagnóstico , Tos/etiología , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Influenza Pandémica, 1918-1919/historia , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Historia del Siglo XX , Historia del Siglo XXI , Monitoreo Epidemiológico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Preparación para una Pandemia , Vacunas contra la Influenza/administración & dosificaciónRESUMEN
A 10-year-old spayed female shih tzu dog was brought to the hospital because of recurring syncope that occurred simultaneously with a cough. Physical examination did not reveal an abnormal heart rhythm or abnormal heart sounds. Electrocardiography revealed sinus arrest of 4.7 s with intermittent escape beats during coughing. Additional examinations, including thoracic radiography, clinical pathology, and echocardiography, revealed no abnormalities of concern. Forty-eight-hour Holter monitoring captured 1 syncopal episode following severe coughing, during which the longest sinus arrest lasted 16 s with intermittent escape beats. This observation confirmed our strong suspicion that coughing was the cause of varying degrees of sinus arrest in this dog. Theophylline, codeine, and short-term prednisolone were prescribed to treat the dog's cough. The daily episodes of syncope ceased and coughing decreased. Subsequent 48-hour Holter monitoring revealed no abnormal pauses, and the owner did not report syncope. Theophylline and codeine were continued for 5 mo, during which time no syncope occurred. To our knowledge, this case provides the first clear evidence of a correlation between cough-induced sinus arrest and syncope in a veterinary patient, as confirmed by Holter monitoring and electrocardiography. Key clinical message: Cough-induced severe bradycardia and syncope were identified in a shih tzu dog. After the antitussive medication was adjusted, the signs resolved.
Bradycardie sévère et syncope provoquées par la toux chez un chienUne chienne shih tzu stérilisée âgée de 10 ans a été amenée à l'hôpital en raison d'une syncope récurrente survenue simultanément avec une toux. L'examen physique n'a révélé aucun rythme cardiaque anormal ni bruits cardiaques anormaux. L'électrocardiographie a révélé un arrêt sinusal de 4,7 s avec des battements d'échappements intermittents lors de la toux. Des examens complémentaires, notamment une radiographie thoracique, des analyses en pathologie clinique et une échocardiographie, n'ont révélé aucune anomalie préoccupante. Une surveillance Holter de 48 heures a capturé 1 épisode syncopal à la suite d'une toux sévère, au cours duquel l'arrêt sinusal le plus long a duré 16 s avec des battements d'échappements intermittents. Cette observation a confirmé nos fortes suspicions selon lesquelles la toux était la cause de divers degrés d'arrêt sinusal chez ce chien. De la théophylline, de la codéine et de la prednisolone de courte durée ont été prescrites pour traiter la toux du chien. Les épisodes quotidiens de syncope ont cessé et la toux a diminué. Une surveillance Holter ultérieure de 48 heures n'a révélé aucune pause anormale et le propriétaire n'a pas signalé de syncope. La théophylline et la codéine ont été poursuivies pendant 5 mois, période pendant laquelle aucune syncope ne s'est produite. À notre connaissance, ce cas constitue la première preuve claire d'une corrélation entre l'arrêt sinusal induit par la toux et la syncope chez un patient vétérinaire, comme le confirme la surveillance Holter et l'électrocardiographie.Message clinique clé :Une bradycardie et une syncope sévères induites par la toux ont été identifiées chez un chien shih tzu. Après ajustement du traitement antitussif, les signes ont disparu.(Traduit par Dr Serge Messier).
Asunto(s)
Bradicardia , Tos , Enfermedades de los Perros , Síncope , Animales , Perros , Femenino , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/tratamiento farmacológico , Síncope/veterinaria , Síncope/etiología , Tos/veterinaria , Tos/etiología , Bradicardia/veterinaria , Bradicardia/etiología , Teofilina/uso terapéutico , Electrocardiografía Ambulatoria/veterinaria , Electrocardiografía/veterinaria , Codeína/uso terapéuticoRESUMEN
Background: Stress urinary incontinence (SUI) is common in women with chronic cough but may be overlooked. Objective: To determine the frequency of underdiagnosis of cough-related SUI and its impact on women's general health status and quality of life (QoL). Methods: Data were analyzed for 147 women with refractory/unexplained chronic cough. Relevant details were collected from clinical charts and a patient-completed survey. General health status was assessed using the EuroQoL visual analogue scale (EQ-VAS) and QoL with the cough-specific Leicester Cough Questionnaire (LCQ). Results: Women were classified into diagnosed (n = 32; 21.8%) or undiagnosed (n = 33; 22.4%) cough-related SUI, and no SUI (n = 82; 55.6%) groups. Women with versus without cough-related SUI perceived poorer health status and greater impact of cough on everyday lives. Mean LCQ scores were significantly lower in cough-related SUI groups versus no SUI group. In multivariate analysis, the presence of cough-related SUI was significantly associated with lower EQ-VAS and LCQ scores. Conclusion: In our cohort, 44% of women had cough-related SUI, and half were undiagnosed. Irrespective of diagnosis, impairment to everyday lives and QoL was similar. Diagnosing cough-related SUI may identify additional patients who can benefit from therapies to suppress cough and improve QoL.
Asunto(s)
Tos , Estado de Salud , Calidad de Vida , Incontinencia Urinaria de Esfuerzo , Humanos , Tos/diagnóstico , Tos/etiología , Tos/psicología , Femenino , Incontinencia Urinaria de Esfuerzo/diagnóstico , Incontinencia Urinaria de Esfuerzo/psicología , Persona de Mediana Edad , Enfermedad Crónica , Adulto , Encuestas y Cuestionarios , Anciano , Tos CrónicaRESUMEN
A 54-year-old female patient presented with recurrent cough and sputum production over the past year and was hospitalized several times. CT examination revealed exudative lesions in both lungs, which were partially absorbed after treatment. However, they recurred shortly after discharge, and the patient had to be readmitted. In the past year, the patient had been hospitalized six times, and her throat swabs were positive for SARS-CoV-2 at four different points in time. After receiving anti-infective and antiviral treatment in other hospitals, the above symptoms were relieved. The patient tested negative for SARS-CoV-2, but symptoms recurred soon after. Eventually, the diagnosis of Goods syndrome was made based on the presence of B-cell loss, decreased immunoglobulin levels, an inverted CD4+/CD8+ ratio on admission, and a previous history of thymoma.
Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Femenino , Persona de Mediana Edad , COVID-19/complicaciones , COVID-19/diagnóstico , Tos/etiología , Relación CD4-CD8 , Enfermedad Crónica , Pulmón/diagnóstico por imagen , Pulmón/patologíaRESUMEN
Haemangioma of the ribs is considered an extremely rare benign tumour. Here, we present a case of a young male with left tenth rib haemangioma vascularised by a costal artery giving the artery of Adamkiewicz presented as chronic cough. This was successfully treated through preoperative embolisation and surgical resection. A preoperative angiogram was performed to identify the origin of the artery of Adamkiewicz. The final diagnosis was confirmed histopathologically. There were no complications in the postoperative course and no recurrence during 12 months of follow-up.
Asunto(s)
Hemangioma , Costillas , Humanos , Masculino , Costillas/diagnóstico por imagen , Costillas/cirugía , Costillas/irrigación sanguínea , Hemangioma/cirugía , Hemangioma/diagnóstico por imagen , Embolización Terapéutica/métodos , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Adulto , Resultado del Tratamiento , Angiografía , Tos/etiologíaRESUMEN
AIM: Pepsin is an enzyme that helps digest protein secreted only from the gastric chief cell in an inactive state. Pepsin is a good marker for acidic gastroesophageal reflux (GER). Its presence in sputum or saliva is considered pathologic. In GER, cough is stimulated by broncho-esophageal neurogenic reflex and aspiration of gastric contents into the airways. GER is the most common cause of cough. Gastric acid reflux is also thought to play a role in Interstitial Lung Disease (ILD) etiology. In many studies, pepsin and bile acid levels in bronchial lavage were high in patients with interstitial lung disease and chronic cough. In our study, we aimed to evaluate pepsin levels in bronchial lavage in patients with ILD and chronic cough and to investigate the relationship between symptoms and reflux treatment. METHODS: Between January 2021 and February 2022, 212 patients who underwent bronchoscopy in our tertiary clinic were evaluated. These patients were divided into three groups: 52 patients with interstitial lung disease, 81 patients with chronic cough, and 79 patients who underwent bronchoscopy with a pre-diagnosis of lung cancer as the control group. Bronchial lavage obtained by bronchoscopy was analyzed for pepsin levels. RESULTS: Shortness of breath and cough were the most common symptoms in all three groups. Pepsin levels were 16.71 ± 8.6 ng/ml in the chronic cough group, 15.6 ± 8.9 ng/ml in the ILD group, and 10.58 ± 5.4 ng/ml in the lung cancer (control) group. Pepsin levels in the ILD and chronic cough group were statistically significantly higher than in the lung cancer group (p:0.00). There was no statistical difference between the ILD group and the chronic cough group regarding pepsin levels. It was found that pepsin levels were lower in the three groups who received anti-reflux treatment. There was no difference in pepsin levels between ILD subgroups. CONCLUSION: Pepsin levels in bronchial lavage were higher in the ILD and chronic cough groups. This suggests that reflux may be involved in the etiology of chronic cough and ILD. Low pepsin values in patients receiving anti-reflux therapy have shown that occult reflux may occur. In our study, the high level of pepsin in bronchial lavage, especially in the chronic cough and ILD group, may be instructive in the etiology and treatment planning of the disease.
Asunto(s)
Tos , Reflujo Gastroesofágico , Enfermedades Pulmonares Intersticiales , Pepsina A , Humanos , Tos/metabolismo , Tos/etiología , Pepsina A/análisis , Pepsina A/metabolismo , Enfermedades Pulmonares Intersticiales/metabolismo , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedad Crónica , Masculino , Femenino , Persona de Mediana Edad , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/metabolismo , Anciano , Líquido del Lavado Bronquioalveolar/química , Lavado Broncoalveolar/métodos , Broncoscopía/métodos , Biomarcadores/metabolismo , Biomarcadores/análisis , Tos CrónicaRESUMEN
BACKGROUND: This study aimed to explore the risk factors for chronic cough in children and provide a reference for prevention and healthcare measures. METHODS: PubMed, Web of Science, Cochrane, and EMBASE were searched for observational studies published up to April 2024. Outcome included risk factors associated with chronic cough in children. Two investigators independently searched and screened the literature, evaluated the qualities and extracted baseline datas. Results were analyzed using random-effects models with odds ratios and their 95 % confidence intervals to address heterogeneity. Subgroup analyses, sensitivity analyses and assessment of publication bias were performed. Stata17 and GRADEwas used for the meta-analysis. RESULTS: 18 studies including 97,462 children were reviewed. Asthma(OR = 4.06, 95%CI: 2.37-6.96, Pï¼0.01), NO2(OR = 1.19, 95%CI: 1.01-1.39, P = 0.031), Home remodeling history (OR = 1.82,95 % CI: 1.61-2.05, Pï¼0.01), Environment Tobacco Smoke(OR = 1.41, 95 % CI: 1.15-1.73, P = 0.001), Pet exposure (OR = 1.56, 95%CI: 1.25-1.95, Pï¼0.01), Mould (OR = 1.64,95%CI: 1.45-1.85, Pï¼0.01), Ageï¼1 year(OR = 3.19, 95 % CI: 1.8-5.63, Pï¼0.01) were reported as risk factors for chronic cough in children, these results were discussed qualitatively in the study. CONCLUSION: Asthma, NO2, Home remodeling history, Environment Tobacco Smoke(ETS), Pet exposure, Mould, and Ageï¼1 year are risk factors for chronic coughing in children. Due to the few studies and insufficient evidence, other potential risk factors need to be robustly confirmed by subsequent large-sample and multicenter trials.
Asunto(s)
Asma , Tos , Humanos , Tos/etiología , Factores de Riesgo , Enfermedad Crónica , Niño , Asma/epidemiología , Contaminación por Humo de Tabaco/efectos adversos , Preescolar , Masculino , Femenino , Adolescente , Lactante , Animales , Tos CrónicaRESUMEN
BACKGROUND: Tuberculosis disease epidemiology is closely related to social and economic conditions which make its prevention, control and cure challenging. Early diagnosis and adequate treatment will help to prevent various tuberculosis related morbidities. Factors such as adverse effects of drugs, transportation cost, family support, distance to the treatment center, personal habits, co morbid conditions, and patients' multiple obligations concerning to their employment, family and society have an impact on the treatment outcomes. OBJECTIVE: To know the factors affecting tuberculosis treatment outcome among newly diagnosed tuberculosis patients. MATERIALS AND METHODS: A total of 261 Tuberculosis patients registered in NTEP under District tuberculosis centre were enrolled using universal sampling method. First follow up was done at the end of intensive phase i.e. End of 2 months. Second follow up was done after completion of treatment i.e., End of 6th month. RESULTS: Majority 59% participants were diagnosed as smear negative at 2nd month follow up and 45.21% and 28.73% participants were diagnosed as cured and treatment completed respectively at 6th month follow up. 73.95% participants had successful outcome. Multivariate logistic regression analysis showed that treatment outcomes of tuberculosis were affected by type of house (pucca house), presence of cough, past history of tuberculosis, family support, supervision by family and support of supervisor. CONCLUSION: Overall treatment success rate was 73.95%. The contributing factors for successful outcome of tuberculosis were age, past history of TB, type of house, presence of cough and fever, weight gain, family support, supervision by family and support of supervisor.
Asunto(s)
Antituberculosos , Humanos , Masculino , Femenino , Adulto , Antituberculosos/uso terapéutico , Estudios Longitudinales , Resultado del Tratamiento , Persona de Mediana Edad , Adulto Joven , India/epidemiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Adolescente , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Tos/etiología , Factores de Edad , Modelos Logísticos , Apoyo SocialRESUMEN
CASE PRESENTATION: A 62-year-old woman came to our hospital with worsening cough and dyspnea over the preceding week, during which time she had been treated with azithromycin and prednisone for suspected pneumonia. She had no fever, chills, or sweats, but her cough had become productive of clear to blood-tinged phlegm during the interval. Medical history was significant for insulin-dependent diabetes mellitus and OSA. She had quit smoking 44 years earlier and had no history of lung disease. She was a bank teller residing in southeastern Minnesota and described no relevant inhalational or environmental exposures, drug use, aspiration, or travels preceding her illness.
Asunto(s)
Tos , Disnea , Tomografía Computarizada por Rayos X , Humanos , Femenino , Persona de Mediana Edad , Tos/etiología , Tos/diagnóstico , Disnea/etiología , Disnea/diagnóstico , Diagnóstico Diferencial , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/etiología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/complicacionesRESUMEN
INTRODUCTION: Refractory or unexplained chronic cough (RUCC) is a common clinical problem with no effective diagnostic tools. The Sensations and Triggers Provoking Cough questionnaire (TOPIC) was developed to characterise cough in RUCC versus cough in other conditions. METHODS: Content analysis of participant interviews discussing the sensations and triggers of chronic cough informed TOPIC development. Participants with chronic cough completed the draft-TOPIC (a subset repeating 5-7 days later), St George's Respiratory Questionnaire (SGRQ), Cough Severity Diary (CSD) and Global Rating of Change Scale. The draft-TOPIC item list was reduced in hierarchical and Rasch analysis to refine the questionnaire to the TOPIC. RESULTS: 49 items describing the triggers and sensations of cough were generated from participant interviews (RUCC n=14, chronic obstructive pulmonary disease (COPD) n=11, interstitial lung disease (ILD) n=10, asthma n=11, bronchiectasis n=3, cystic fibrosis n=7). 140 participants (median age 60.0 (19.0-88.0), female 56.4%; RUCC n=39, ILD n=38, asthma n=45, COPD n=6, bronchiectasis n=12) completed draft-TOPIC, where items with poor 'fit' for RUCC were removed to create TOPIC (8 trigger items, 7 sensation items). Median TOPIC score was significantly higher in RUCC (37.0) vs ILD (24.5, p=0.009) and asthma (7.0, p<0.001), but not bronchiectasis (20.0, p=0.318) or COPD (18.5, p=0.238), likely due to small sample sizes. The Rasch model demonstrated excellent fit in RUCC (χ2=22.04, p=0.85; PSI=0.88); as expected. When all participant groups were included, fit was no longer demonstrated (χ2=66.43, p=0.0001, PSI=0.89) due to the increased heterogeneity (CI=0.077). TOPIC correlated positively with SGRQ (r=0.47, p<0.001) and CSD (r=0.63, p<0.001). The test-retest reliability of TOPIC (intraclass correlation coefficient) was excellent (r=0.90, p<0.001). CONCLUSIONS: High TOPIC scores in the RUCC patients suggest their cough is characterised by specific sensations and triggers. Validation of TOPIC in cough clinics may demonstrate value as an aid to identify features of RUCC versus cough in other conditions.
Asunto(s)
Tos , Humanos , Tos/etiología , Tos/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Anciano , Encuestas y Cuestionarios , Enfermedad Crónica , Adulto , Anciano de 80 o más Años , Adulto Joven , Sensación , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatología , Asma/diagnóstico , Asma/complicaciones , Asma/fisiopatología , Índice de Severidad de la Enfermedad , Reproducibilidad de los Resultados , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/complicaciones , Fibrosis Quística/complicaciones , Fibrosis Quística/fisiopatología , Tos CrónicaRESUMEN
AIM: This study aims to evaluate the feasibility and clinical utility of measuring cough decibel level as predictive markers for extubation outcomes in mechanically ventilated patients. DESIGN: A prospective observational study. SETTING: Three interdisciplinary medical-surgical intensive care units across China. MAIN OUTCOME MEASURES: The primary outcomes assessed were extubation results in patients. Secondary measures included the cough decibel level, semiquantitative cough intensity scores, and white card test results recorded prior to extubation. RESULTS: A total of 71 patients were included, 55 patients were in the extubation success group and 16 in the failure group. The mean age was 78(71,83) years, mainly male (73.2 %). Despite the baseline characteristics being mostly consistent across both groups, significant differences were noted in duration of mechanical ventilation, and intensive care units and hospital stay. Remarkably, the cough decibel was substantially lower in the extubation failure group compared to the other group (78.69 ± 8.23 vs 92.28 ± 7.01 dB). The Receiver Operating Characteristic curve analysis revealed that a cough decibel below 85.77 dB is the optimal threshold for predicting extubation failure, exhibiting an 80 % sensitivity and 91.67 % specificity. CONCLUSION: The study corroborates that the cough decibel level serves as a quantifiable metric in patients undergoing mechanical ventilation. It posits that the likelihood of extubation failure escalates when the cough decibel falls below 85.77 dB. IMPLICATIONS FOR CLINICAL PRACTICE: Quantification of coughing capacity in decibels may be a good predictor of extubation outcome, thus offering assistance to healthcare professionals in evaluating the readiness of patients for extubation.
Asunto(s)
Extubación Traqueal , Tos , Unidades de Cuidados Intensivos , Respiración Artificial , Humanos , Estudios Prospectivos , Masculino , Femenino , Tos/fisiopatología , Tos/etiología , Anciano , Extubación Traqueal/métodos , Extubación Traqueal/estadística & datos numéricos , Extubación Traqueal/normas , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Anciano de 80 o más Años , China , Desconexión del Ventilador/métodos , Desconexión del Ventilador/estadística & datos numéricos , Desconexión del Ventilador/normas , Curva ROC , Valor Predictivo de las Pruebas , Persona de Mediana EdadRESUMEN
Asunto(s)
Pruebas Respiratorias , Tos , Sensibilidad y Especificidad , Tuberculosis Pulmonar , Humanos , Masculino , Femenino , Tos/diagnóstico , Tos/etiología , Persona de Mediana Edad , Perú , Adulto , Estudios Prospectivos , Tuberculosis Pulmonar/diagnóstico , Factores de Riesgo , Triaje , Anciano , Hospitalización , Adulto Joven , Esputo/microbiologíaRESUMEN
Background and Objectives: The term long COVID refers to patients with a history of confirmed COVID-19 infection, who present symptoms that last for at least 2 months and cannot be explained by another diagnosis. Objectives: The present study aims to determine the most common symptoms of the long COVID syndrome and their impact on the quality of life. Materials and Methods: A prospective observational study was conducted on patients diagnosed with mild and moderate COVID-19 (based on a positive SARS-CoV-2 molecular diagnostic or rapid antigen test and severity form definition) at the Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania. Clinical examinations with detailed questions about symptoms were performed at the time of the diagnosis of COVID-19 and the six-month follow-up. Two years after COVID-19 infection, patients were invited to complete an online quality-of-life questionnaire regarding long COVID symptoms. Results: A total of 103 patients (35.92% males) with a mean age of 41.56 ± 11.77 were included in this study. Of the total number of patients, 65.04% presented mild forms of COVID-19. Data regarding the vaccination status showed that 83.5% were vaccinated against SARS-CoV-2. The most common symptoms at diagnosis were cough (80.6%), fatigue (80.4%), odynophagia (76.7%), and headaches (67.6%), with female patients being statistically more likely to experience it (p = 0.014). Patients with moderate forms of the disease had higher levels of both systolic (p = 0.008) and diastolic (p = 0.037) blood pressure at diagnosis, but no statistical difference was observed in the 6-month follow-up. The most common symptoms at 2 years (in 29 respondent subjects) were represented by asthenia (51.7%), headache (34.5%), memory disorders (27.6%), abdominal meteorism (27.6%), and arthralgia (27.6%). In terms of cardiovascular symptoms, fluctuating blood pressure values (20.7%), palpitations (17.2%), and increased heart rate values (17.2%) were recorded. Conclusions: If at the time of diagnosis, the most frequent manifestations of the disease were respiratory, together with headache and fatigue, at re-evaluation, asthenia, decreased effort tolerance, and neuropsychiatric symptoms prevailed. Regarding the cardiovascular changes as part of the long COVID clinical picture, some patients developed prehypertension, palpitations, and tachycardia.
Asunto(s)
COVID-19 , Síndrome Post Agudo de COVID-19 , Calidad de Vida , SARS-CoV-2 , Humanos , Femenino , Masculino , COVID-19/epidemiología , COVID-19/complicaciones , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Rumanía/epidemiología , Encuestas y Cuestionarios , Fatiga/etiología , Cefalea/etiología , Tos/etiología , Tos/fisiopatologíaRESUMEN
INTRODUCTION: Significant numbers of patients undergoing minimally invasive lung surgery develop chronic symptoms such as chronic pain and chronic cough after surgery, which may lead to a reduced quality of life (QoL). Despite this, there remains a dearth of high-quality prospective studies on this topic. Therefore, our study aims to systematically investigate the incidence and progression of long-term chronic symptoms following minimally invasive lung surgery, as well as changes in patient's psychological status and long-term QoL. METHODS: This is a single-centre, observational, prospective study that included patients with stage I non-small cell lung cancer or benign lesions. Prior to surgery, patients' baseline levels of chronic pain, chronic cough and sleep will be documented. Anxiety, depression and QoL assessments will be conducted using the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer (EORTC) 30-item QoL Questionnaire (QLQ-C30). Following surgery, pain and cough will be evaluated during the initial 3 days using the Numeric Pain Rating Scale and Visual Analogue Scale score, with assessments performed thrice daily. Additionally, sleep status will be recorded daily during this period. Subsequently, postoperative chronic symptoms and QoL will be assessed at weeks 1, 2, 4, 12, 26 and 52. Chronic cough will be evaluated using the Leicester Cough Questionnaire, chronic pain will be assessed via the Brief Pain Inventory and McGill Pain Questionnaire while the EORTC QLQ-C30 questionnaire and HADS will provide continuous monitoring of QoL, anxiety and depression statuses. Data will also include the timing of chronic symptom onset, predisposing factors, as well as aggravating and relieving factors. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethics Committees of Fujian Medical University Union Hospital. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT06016881.
Asunto(s)
Tos , Neoplasias Pulmonares , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias , Calidad de Vida , Humanos , Estudios Prospectivos , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/psicología , Tos/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/psicología , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Estudios Observacionales como Asunto , Ansiedad/etiología , Depresión/etiología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/psicología , Enfermedad Crónica , Dolor Crónico/etiología , Dolor Crónico/psicología , Neumonectomía/efectos adversosRESUMEN
AIM: To study the efficacy and safety of Eladis® in comparison with placebo in patients with non-productive cough. MATERIALS AND METHODS: A phase III clinical trial enrolled 250 patients aged 18-65 years with acute respiratory viral infection with upper respiratory tract involvement or acute bronchitis. Patients were randomized into 2 groups of 125 subjects: group 1 received Eladis® (40 mg tablets), group 2 received a matching placebo. The patients received the study drugs 1 tablet BID for 7-14 days. After the treatment, patients were followed up (day 7±2) to assess the effect of therapy on the frequency of coughing attacks, the frequency and severity of daytime and nocturnal cough, the severity of cough, the duration of clinical cough cure, and the effect on the severity of the main acute respiratory viral infection symptoms. RESULTS AND CONCLUSION: The results of the study demonstrate the overall efficacy and statistically significant superiority of Eladis® over placebo: there were significant differences between the study groups in the proportion of patients who decreased the coughing attack frequency by ≥50% by day 5 (p<0.0001). In addition, the clinical cure of cough in the Eladis® group occurred 2 days earlier: the median time was 6 days, vs 8 days in placebo group. There was a decrease in the frequency of cough attacks and a decrease in its severity by more than 3.5 points by day 5 of treatment. All the effects were associated with high safety of the drug.
Asunto(s)
Tos , Infecciones del Sistema Respiratorio , Humanos , Tos/tratamiento farmacológico , Tos/etiología , Masculino , Adulto , Femenino , Persona de Mediana Edad , Método Doble Ciego , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Resultado del Tratamiento , Adulto Joven , Antitusígenos/administración & dosificación , Antitusígenos/uso terapéutico , Adolescente , Virosis/tratamiento farmacológico , AncianoRESUMEN
BACKGROUND: The SARS-CoV-2 pandemic, pharyngeal anesthesia such as nebulizer or lidocaine pump spray is the risk of droplet transmission to health care workers from coughing due to spraying anesthesia. Absence of pharyngeal anesthesia may induce coughing and reduce patient and operator satisfaction, but the efficacy of pharyngeal anesthesia under sedation is still limited. Therefore we evaluated a prospective, randomized, single-blind trial to evaluate efficacy of pharyngeal anesthesia in patients receiving sedation. MATERIALS AND METHODS: We conducted a randomized comparison of pharyngeal anesthesia with or without bronchoalveolar lavage in patients undergoing bronchoscopy at our hospital between March and October 2022. Pharyngeal anesthesia was performed using 8ï¼ lidocaine spray and the operators were blinded to eliminate bias. Two hundred patients were entered into the study and divided into two groups: those who received pharyngeal anesthesia(control group) and did not receive pharyngeal anesthesia(test group). The primary endpoint was the operator's satisfaction with the procedure. The secondary endpoints were the patient's cough during the examination as perceived by the operator, cough and discomfort experienced by the patient and the dose of analgesic/sedative/lidocaine administered. These scales were scored from 0 to 100. RESULT: In primary endpoint, there was no significant difference in the operator-rated procedure satisfaction between the 2 groups. The median for the discomfort score for patients in the control group was tendency higher than in the test group. There were no significant differences in other secondary endpoints. CONCLUSION: Pharyngeal anesthesia may not be recommended for flexible bronchoscopy performed under combined sedation and analgesia. TRIAL REGISTRATION: Registration number: UMIN000046975Date of registration: 2022/03/07.
Asunto(s)
Lavado Broncoalveolar , Broncoscopía , Tos , Lidocaína , Faringe , Humanos , Broncoscopía/métodos , Broncoscopía/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Tos/etiología , Método Simple Ciego , Estudios Prospectivos , Anciano , Lavado Broncoalveolar/métodos , Anestésicos Locales/administración & dosificación , Satisfacción del Paciente , Adulto , COVID-19/prevención & controlRESUMEN
BACKGROUND: Viral or atypical bacterial respiratory infections are involved in the new development and the pathogenesis of asthma. Though an association between pertussis and asthma has been expected, few studies have reported it consistently. We assessed the prevalence and clinical relevance of pertussis infection in adult patients with asthma. METHODS: In this prospective, cross-sectional study, newly referred, adult patients with asthma (n = 107) and with non-asthmatic subacute/chronic cough (n = 31) were enrolled. The prevalence of pertussis in patients with asthma and in those with non-asthmatic subacute/chronic cough was assessed. Next, the prevalence of newly diagnosed asthma was compared between asthmatic patients with and without pertussis. Finally, demographic characteristics of patients, blood test results, pulmonary function test results, and questionnaire scores were compared between the two patient groups. RESULTS: The prevalence of pertussis infection was significantly higher in patients with asthma than in those with non-asthmatic subacute/chronic cough (36% vs 10%; P = 0.004). The prevalence of newly diagnosed asthma was significantly higher in asthmatic patients with pertussis than in those without (74.4% vs 50.0%; P = 0.014). The physical, psychological, and total scores of the Leicester Cough Questionnaire were significantly lower in asthmatic patients with pertussis than in those without (all P < 0.05). The acid-reflux, dyspeptic, and total scores of the Frequency Scale for Symptoms of Gastroesophageal Reflux Disease (GERD) (FSSG) were significantly higher in asthmatic patients with pertussis than in those without (all P ≤ 0.05). The FSSG acid-reflux score was negatively correlated with the cough-specific quality of life (QOL) score only in asthmatic patients with pertussis (rho = -0.68, P = 0.01). CONCLUSIONS: The prevalence of pertussis infection was significantly higher in adult patients with asthma than in those with non-asthmatic subacute/chronic cough. In patients with asthma, comorbid pertussis infection may play a role in newly diagnosed asthma and may contribute to impaired cough-specific QOL partly due to worsening acid-reflux symptoms of GERD.
Asunto(s)
Asma , Tos Ferina , Humanos , Asma/epidemiología , Asma/complicaciones , Estudios Transversales , Prevalencia , Tos Ferina/epidemiología , Tos Ferina/complicaciones , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Comorbilidad , Encuestas y Cuestionarios , Tos/epidemiología , Tos/etiología , Enfermedad Crónica , Relevancia ClínicaRESUMEN
INTRODUCTION: Neurogenic cough (NC) is thought to be related to sensory neuropathy in the hypopharynx and larynx. Defined as a cough persisting longer than 8 weeks refractory to standard therapy, it is a diagnosis of exclusion when other common etiologies (asthma, gastroesophageal reflux disease (GERD), medication side effects) are ruled out. It affects roughly 11 % of Americans and can negatively impact quality of life. METHODS: Following institutional review board approval, we evaluated the medical records of adult patients seen at the University of Arizona's tertiary laryngology center from 2018 to 2023. Patients were included if their cough persisted for >8 weeks, and they either did not respond to prior proton pump inhibitor and asthma therapy or had GERD and asthma ruled out. These patients underwent a progressive escalation of therapy, which included neuromodulators with or without cough suppression therapy, superior laryngeal nerve (SLN) block, and laryngeal botulinum toxin injections. The primary outcome was patient-reported improvement in cough symptoms rated on a 1-5 scale: 1 = no response, 2 = mild improvement, 3 = moderate improvement, 4 = significant improvement, 5 = complete resolution. RESULTS: A total of 56 patients were included. Mean (SD) age was 64.6 (14.8) years, and 66 % were female. Overall, 42 patients (75.0 %) responded to treatment. Among responders, 7 (16.7 %) experienced mild improvement, 14 (33.3 %) experienced moderate improvement, 17 (40.5 %) experienced significant improvement, and 4 (9.5 %) experienced complete resolution of their cough. 33 patients (58.9 %) were managed exclusively with neuromodulators ± cough suppression therapy; 27 responded, with an average response rating of 3.0 (SD = 1.2). 11 patients (19.6 %) failed medical therapy and underwent SLN block without subsequent botox treatment; 7 responded, with an average response rating of 2.5 (SD = 1.4). 9 patients (16.1 %) failed all previous therapies and underwent laryngeal botulinum toxin injections; 6 responded with an average response rating of 2.4 (SD = 1.3). The remaining 3 patients underwent cough suppression therapy alone, with 2 responding and an average response rating of 3.3 (SD = 1.7). CONCLUSIONS: Neurogenic cough can be effectively treated with a stepwise multimodal approach, including neuromodulators, cough suppression therapy, SLN block, and laryngeal botulinum toxin injections.